Regional variations in cancer survival: Impact of tumour stage, socioeconomic status, comorbidity, and type of treatment in Norway.

Cancer survival varies by place of residence, but it remains uncertain whether this reflects differences in tumour-, patient- and treatment characteristics (including tumour stage, indicators of socioeconomic status (SES), comorbidity and information on received surgery and radiotherapy) or possibly regional differences in the quality of delivered health care.

National population-based data from the Cancer Registry of Norway were used to identify cancer patients diagnosed in 2002-2011 (n = 258 675). We investigated survival from any type of cancer (all cancer sites combined), as well as for the six most common cancers. The effect of adjusting for prognostic factors on regional variations in cancer survival was examined by calculating the mean deviation, defined by the mean absolute deviation of the relative excess risks (RER) across health services regions. For prostate cancer, the mean deviation across regions was 1. 78 when adjusting for age and sex only, but decreased to 1. 27 after further adjustment for tumour stage. For breast cancer, the corresponding mean deviations were 1. 34 and 1. 27. Additional adjustment for other prognostic factors did not materially change the regional variation in any of the other sites. Adjustment for tumour stage explained most of the regional variations in prostate cancer survival, but had little impact for other sites. Unexplained regional variations after adjusting for tumour stage, SES indicators, comorbidity, and type of treatment in Norway may be related to regional inequalities in the quality of cancer care. This article is protected by copyright. All rights reserved.

International journal of cancer. Journal international du cancer. 2015 Dec 17 [Epub ahead of print]

Katrine Damgaard Skyrud, Freddie Bray, Morten Tandberg Eriksen, Yngvar Nilssen, Bjørn Møller

Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, P. O. Box 5313 Majorstuen, 0304, Oslo, Norway. , Section of Cancer Surveillance, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon CEDEX 08, France. , Department of Digestive and Paediatric Surgery, Oslo University Hospital, 0424, Oslo, Norway. , Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, P. O. Box 5313 Majorstuen, 0304, Oslo, Norway. , Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, P. O. Box 5313 Majorstuen, 0304, Oslo, Norway.

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